Supplementary dental insurance for braces: what it covers
The most important sentence is in every contract: treatments already advised are excluded.
Supplementary dental insurance can cover a considerable part of orthodontic costs – if it was taken out in time. That is exactly where most cases fail.
The exclusion everyone overlooks
Almost every policy excludes treatments that were already advised, begun or announced when the contract was signed. The dentist’s remark “an orthodontist should have a look at that” can be enough. Anyone who takes out the insurance after the brace has been recommended pays premiums without receiving benefits.
What to look for in a policy
- Waiting period: many policies only pay after eight months to two years.
- Graduated limits: in the first years often only a maximum amount per year.
- KIG restrictions: some policies pay only for KIG (German orthodontic indication groups) 1 and 2, i.e. exactly where statutory health insurance does not pay – others exclude that.
- Age limits: cover for orthodontics often ends at 18 or 21.
- Reimbursement rates: 50, 80 or 100 per cent – and of what: of the total costs or of your own share.
For children
The sensible time is long before the first appointment with the orthodontist – in the toddler years, when nothing is yet foreseeable. That feels premature, and it is the only time at which taking out a policy reliably holds.
For adults
Many policies exclude orthodontics for adults altogether. Where it is included, the same rules apply – and the same trap of treatment that has already been advised.
The key points at a glance
- Almost every policy excludes treatments that have already been advised. The dentist’s remark can be enough for that.
- Check the waiting period, annual maximum amounts, KIG restrictions, age limits and what the reimbursement rate is calculated from.
- For children the sensible time is the toddler years – long before anything is foreseeable.
- Many policies exclude orthodontics for adults altogether.
Answered briefly
Frequently asked questions
As a rule, no. The treatment then counts as already advised and is excluded. Ask the insurer in writing before you sign – a verbal statement is no help in a dispute.
Some plans pay precisely when statutory health insurance does not – that is, for KIG 1 and 2. Others only pay in addition to the statutory benefit, that is, from KIG 3 upwards. This is the point where plans differ most.
If orthodontic services are included, usually yes – but often capped. Submit the treatment and cost plan before treatment begins and get the commitment in writing.
After the waiting period, which is eight months to two years depending on the plan. Some plans waive it – then the graduated limits in the first years are usually all the stricter.